Simple self-monitoring protocol improves glycemic control

Abstract

MedWire News: Fortnightly self-monitoring of blood glucose is associated with better glycemic control than monthly monitoring, a study of people with Type 2 diabetes suggests.

Importantly, however, the improvement was apparent only in people who were compliant with self-monitoring, and compliance was much higher in the group who monitored monthly rather than fortnightly.

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The findings are reported by an Italian team of researchers, who undertook a randomized trial to evaluate two protocols for self-monitoring of blood glucose (SMBG): Less intensive (one blood glucose profile each month, with fasting and post-prandial values) versus more intensive (blood glucose profile fortnightly, with pre- and post-prandial values).

The subjects were 273 people with Type 2 diabetes who were not taking insulin and had a glycated hemoglobin (HbA1c) level above 7%. All were already using SMBG and attending a diabetes clinic.

All patients received education and instructions on the SMBG protocols and agreed to follow the allocated monitoring schedules; they were also encouraged to increase compliance with diet and exercise if blood glucose targets were not reached.

Six months after randomization, HbA1c had fallen by 0.25% in the less-intensive monitoring group and by 0.23% in the more-intensive group, a non-significant difference.

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Compliance with SMBG – defined as performing at least 70% of scheduled measurements – differed markedly between the groups, at 73% in the less-intensive group versus 44% in the more-intensive group.

In an analysis restricted to patients who had been compliant with monitoring, HbA1c fell by 0.19% in the less-intensive monitoring group versus 0.49% in the more-intensive group, a highly significant difference.

Furthermore, among compliant patients, blood glucose levels decreased significantly in the more-intensive monitoring group but were unchanged in the less-intensive group.

Mariella Trovati (Turin University) and fellow investigators say that compliance “was paramount in achieving the results,” since when compliant and non-compliant patients were considered together the two SMBG protocols showed a similar influence on blood glucose control.

They conclude: “A relatively simple SMBG policy for people with Type 2 diabetes not on insulin… could be potentially useful when performed with sufficient compliance.

“It is widely accepted that to influence glycemic control SMBG results require understanding and combined action on the part of patients and health care professionals.”